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Required Programs

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that established a prior authorization (PA) process as a condition of payment for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization.

The Master List contains the DMEPOS items identified as being frequently subject to unnecessary utilization, however presence this list does not automatically create a PA requirement for that item. CMS will implement a subset of items from the Master List (referred to as the "Required Prior Authorization List") and publish in the Federal Register with at least 60 days' notice before PA implementation of those items.

The final rule can be found here: https://www.federalregister.gov/articles/2015/12/30/2015-32506/medicare-program-prior-authorization-process-for-certain-durable-medical-equipment-prosthetics

Current Required Prior Authorization Listing

 

Last Updated Jan 22, 2018